Disseminated Visceral Infection with Mycobacterium fortuitum in a Hemodialysis Patient

Abstract

A 2 8-year-old patient with chronic renal failure on maintenance hemodialysis developed fever, granulomatous hepatitis, pulmonary infiltrates, sacroiliitis, and spondylitis which were unresponsive to conventional antituberculous treatment. Cultures of the sputum gave repeated growth of Mycobacterium fortuitum. This organism was resistant ‘in vitro’ to most antituberculous drugs and sensitive to some aminoglycosides and doxycycline. No mycobacteria were found in the water used for dialysis. The patient was successfully treated with amikacin and doxycycline. Nontuberculous mycobacterial infection should be considered in the differential diagnosis of febrile illnesses resembling tuberculosis in hemodialysis patients. Defective immune mechanisms could contribute to this complication. Since M. fortuitum is usually resistant to antituberculous drugs, precise identification and sensitivity testing are essential for optimal management.

Tuberculosis and Chronic Renal Disease

“…These NTM are ubiquitous organisms, living in soil, water, and dust. Infections with these organisms, in particular group IV (the rapidly growing mycobacteria, including Mycobacterium fortuitum and chelonae ) have been reported in patients on PD, causing exit site infections and peritonitis (61–69), and more rarely, in HD patients (70–75). These infections are often, but not always, due to contaminated water or dialysis fluid, or in cases of HD, by infected dialyzers (72,76).…”

Disseminated tuberculosis: A neglected entity in immunocompromised hemodialysis patients

“…9 Disseminated nontuberculous infections in hemodialysis patients have only been reported in sporadic cases of infections of the dialysis water circuit 11,12 or other unrecognized causes. 13 Underlying pathophysiology predisposing to disseminated tuberculosis infection in our patient may involve several mechanisms. Firstly, patients with advanced renal failure are characterized by impaired cellular immunity.…”

“…Disseminated tuberculosis has been described only in three case reports, two hemodialysis patients presenting with hypercalcemia, and one patient under continuous ambulatory peritoneal dialysis . Disseminated nontuberculous infections in hemodialysis patients have only been reported in sporadic cases of infections of the dialysis water circuit or other unrecognized causes …”